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Öğe Assessment of risk factors on morbidity and mortality in patients undergoing percutaneous endoscopic gastrostomy(2018) Karaman, Kerem; Aziret, Mehmet; Ercan, Metin; Celebi, Fehmi; Akdeniz, Yesim; Ebiloglu, TugceAim: Percutaneous endoscopic gastrostomy (PEG) is a minimal invasive procedure that is performed in patients who are unable to take oral feeding. Herein, we aimed to assess the risk factors for morbidity and mortality in patients who undergo PEG. Material and Methods: This study was conducted, in a total of 143 patients who underwent PEG for enteral feeding, who were retrospectively analyzed in terms of clinical features, biochemical, hematological and microbiological parameters, and also morbidity and mortality. Results: The study enrolled 140 of 143 consecutive patients who underwent PEG, and a total of 206 interventions were performed. The rate of successful insertion was 98.5% (140/142). Complications were peristomal leakage (%29.3), infection due to PEG (9.3%), and tube blockage (6.4%), respectively. In multivariate logistic regression analysis; a ≤ 3.5cm length of the PEG tube between the gastric mucosa and the skin (95% CI: 1.290-33.442 and P= 0.023) and a low platelet lymphocyte ratio (OR = 0.994, 95% CI: 0.989- 0.999 and p = 0.022) were risk factors of peristomal leakage. The 30-day mortality rate was 16%. Discussion: In patient with PEG, the complication rate varies between 5% and 66% according to follow-ups in the literature. The mortality usually depends on the primary disease, and it has been reported between 5% and 20%. Conclusion: PEG is a safe, effective, and minimal invasive procedure. A ≤3.5 cm length of a PEG tube between the gastric mucosa and skin and a low platelet lymphocyte ratio are risk factors for the development of peristomal leakage.Öğe Comparing the effects of bascom’s cleft lift and crystallized phenol treatment on Type III-V Pilonidal Sinus Disease(2021) Yirgin, Hakan; Aziret, MehmetAim: We aimed to compare the efficacy of Bascom cleft lift (BCL) and crystallized phenol application in the treatment of sacrococcygeal pilonidal sinus (SPS).Materials and Methods: This study included 83 SPS patients who were divided into two groups for treatment with either BCL (Group 1: n=30) or crystallized phenol (Group 2: n=53). The two groups were compared in terms of patient characteristics, perioperative results, rates of surgical site infection, hematoma and wound dehiscence, times of returning to daily activities, complete healing time and overall patient satisfaction.Results: The median follow-up was 40.3 (38.7-44.7) months. The length of hospital stay was longer in the BCL group than in the crystallized phenol group (P0.001). The median return to work or school was also slower in the BCL group than in the phenol group at 10 (3.2-7.7) and 3 (2-8.7) days, respectively (P=0.002). The phenol group were able to sit pain-free on the toilet earlier than the BCL group in 0.5 (1.1-9.7) and 3 (1.8-10.3) days (P=0.029), and also started lifting weights earlier 14.5 (6-50.2) days vs. 30 (18.1-41.6) days (P=0.011). Moreover, the phenol group reported greater patient satisfaction (P=0.004). On the other hand, the BCL group was more successful than the phenol group in terms of recurrence (P=0.082).Conclusion: Our results suggest that crystallized phenol can achieve higher patient satisfaction, less hospitalization time, and an earlier return to daily activities, school or work. On the other hand, Bascom cleft lift method results in less recurrence than crystallized phenol treatment.Öğe Interaction between pancreatic fluid and three different hemostatic agents: an in-vitro study(2019) Oter, Volkan; Karaman, Kerem; Bal, Ali; Aziret, Mehmet; Ercan, Metin; Bostanci, Erdal BirolAim: Although recent developments in surgery led to mortality reduction under 2%, postoperative pancreatic fistula (POPF) remains high reported from 20% up to 40%. Primary aim of the present in-vitro study was to determine the interaction between pancreatic fluid and three different hemostatic agents.Material and methods: Three different hemostatic agent; fibrin sealant Tisseel, Floseal and Ankaferd Blood Stopper (ABS) were mixed in tubes with pancreatic fluid in equal proportions. The length of the gel aggregate of each sample which covers the pancreatic fluid in the tube was measured as mm and thereafter statistically compared.Results: Tisseel significantly formed an intensely thicker gel than Floseal and ABS (Tisseel vs FloSeal; P0.0001, Tisseel vs ABS; P0.0001). Further, the thickness of the gel formation was significantly higher in FloSeal-pancreatic fluid mixture than the ABS-pancreatic fluid mixture (P0.0001). Under light microscope, Tisseel formed a much more homogenous and dens mixture than Floseal and ABS.Conclusion: Tisseel fibrin sealant has beneath its hemostatic properties also the potential of preventing pancreatic fistula development. Further in-vitro and in-vivo studies are needed to reach a definitive conclusion.Keywords: Hemostasis; Pancreatic Fistula; Hemostatic Agents; Interaction.Öğe Recovery of hypoglycemia symptoms after insulinoma negative pancreatic surgery: Case series(2017) Şentürk, Adem; Aziret, Mehmet; Ercan, Metin; Bostancı, Erdal Birol; Akoğlu, MusaAbstract:Insulinoma, one of the most common endocrine tumors of the pancreas, is usually benign, solitary and has an intrapancreatic location. Precise localization of insulinoma is important for curative treatment. This study looks at 5 patients who underwent operation for insulinoma. The median age, body mass index, preoperative insulin and C-peptide levels, and length of hospital stay were 36 years, 27 kg/m2, 32 μU/ml, 7ng/ml and 21 days, respectively. An endoscopic ultrasound (EUS) and intraoperative ultrasound (I-OUS) were conducted on all of the patients. Enucleation was performed on 3 patients and distal pancreatectomy ± splenectomy on 2 patients. Furthermore, the histopathological examination conducted on the patients showed insulinoma in 3 patients and granulomatous lymphadenitis in 1 patient, with one observed to have normal pancreas tissues. Following the operation, the glucose level of all patients was found to be within a normal range. Distal pancreatectomy and enucleation can only be performed after determining precise localization of insulinoma via EUS and I-OUS.Öğe Recovery of hypoglycemia symptoms after insulinoma negative pancreatic surgery: Case series(2017) Aziret, Mehmet; Ercan, Metin; Senturk, Adem; Bostanci, Erdal Birol; Akoglu, MusaInsulinoma, one of the most common endocrine tumors of the pancreas, is usually benign, solitary and has an intrapancreatic location. Precise localization of insulinoma is important for curative treatment. This study looks at 5 patients who underwent operation for insulinoma. The median age, body mass index, preoperative insulin and C-peptide levels, and length of hospital stay were 36 years, 27 kg/m2, 32 μU/ml, 7ng/ml and 21 days, respectively. An endoscopic ultrasound (EUS) and intraoperative ultrasound (I-OUS) were conducted on all of the patients. Enucleation was performed on 3 patients and distal pancreatectomy ± splenectomy on 2 patients. Furthermore, the histopathological examination conducted on the patients showed insulinoma in 3 patients and granulomatous lymphadenitis in 1 patient, with one observed to have normal pancreas tissues. Following the operation, the glucose level of all patients was found to be within a normal range. Distal pancreatectomy and enucleation can only be performed after determining precise localization of insulinoma via EUS and I-OUS.Öğe Surgical removal of a self-expanding metallic stent from jejunum in a patient with Roux-en-Y esophagojejunostomy(2020) Subasi, Ozkan; Karaman, Kerem; Aziret, Mehmet; Eminler, Ahmet Tarik; Koksal, Aydin Seref; Ercan, MetinSelf-expanding metallic stent is useful in esophageal perforations, trachea-esophageal fistulas, benign esophageal strictures, and unresectable esophageal cancers. However, self-expanding metallic stent itself has the risk of mucosal necrosis with subsequent perforation and /or trachea-esophageal fistula development –particularly- in long-term usage. Further, gastro-esophageal reflux, stent occlusion, stent migration and intestinal obstruction are other common complications. We report surgical management of a case whose self-expanding metallic stent migrated from the esophagojejunostomy anastomosis towards to the jejunal Y-limp.Öğe Transureteroureterostomy for non-urologic pelvic malignancy: A case report(2021) Karaman, Kerem; Halis, Fikret; Mansiroglu, Cemalettin Kaan; Koyun, Bulent; Aziret, Mehmet; Ercan, MetinThe involvement of the ureter from a pelvic mass requires meticulous handling after resection of the invaded segment. The type of ureteral reconstruction depends on the location of the tumor and the length of the residual ureteral segment. Further, the type of reconstructive technique is also decisive in the patient’s life quality. We report a case with recurrent recto-sigmoid cancer whose tumor mass also invades the left ureter.
